Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, No.1650, Sec.4, Taiwan Boulevard, Taichung, 40705, Taiwan.
Division of Translational Medicine, Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.
Arthritis Res Ther. 2023 May 5;25(1):75. doi: 10.1186/s13075-023-03060-4.
Outdoor air pollution has been found to trigger systemic inflammatory responses and aggravate the activity of certain rheumatic diseases. However, few studies have explored the influence of air pollution on the activity of ankylosing spondylitis (AS). As patients with active AS in Taiwan can be reimbursed through the National Health Insurance programme for biological therapy, we investigated the association between air pollutants and the initiation of reimbursed biologics for active AS.
Since 2011, hourly concentrations of ambient air pollutants, including PM2.5, PM10, NO2, CO, SO2, and O3, have been estimated in Taiwan. Using Taiwanese National Health Insurance Research Database, we identified patients with newly diagnosed AS from 2003 to 2013. We selected 584 patients initiating biologics from 2012 to 2013 and 2336 gender-, age at biologic initiation-, year of AS diagnosis- and disease duration-matched controls. We examined the associations of biologics initiation with air pollutants exposure within 1 year prior to biologic use whilst adjusting for potential confounders, including disease duration, urbanisation level, monthly income, Charlson comorbidity index (CCI), uveitis, psoriasis and the use of medications for AS. Results are shown as adjusted odds ratio (aOR) with 95% confidence intervals (CIs).
The initiation of biologics was associated with exposure to CO (per 1 ppm) (aOR, 8.57; 95% CI, 2.02-36.32) and NO2 (per 10 ppb) (aOR, 0.23; 95% CI, 0.11-0.50). Other independent predictors included disease duration (incremental year, aOR, 8.95), CCI (aOR, 1.31), psoriasis (aOR, 25.19), use of non-steroidal anti-inflammatory drugs (aOR, 23.66), methotrexate use (aOR, 4.50; 95% CI, 2.93-7.00), sulfasalazine use (aOR, 12.16; 95% CI, 8.98-15.45) and prednisolone equivalent dosages (mg/day, aOR, 1.12).
This nationwide, population-based study revealed the initiation of reimbursed biologics was positively associated with CO levels, but negatively associated with NO levels. Major limitations included lack of information on individual smoking status and multicollinearity amongst air pollutants.
已发现室外空气污染会引发全身炎症反应，并加重某些风湿性疾病的活动。然而，很少有研究探讨空气污染对强直性脊柱炎（AS）活动的影响。由于台湾的活动期 AS 患者可以通过全民健康保险计划获得生物治疗报销，因此我们调查了空气污染物与开始报销用于活动期 AS 的生物制剂之间的关联。
自 2011 年以来，已在台湾估算了每小时环境空气污染物（包括 PM2.5、PM10、NO2、CO、SO2 和 O3）的浓度。我们使用台湾全民健康保险研究数据库，从 2003 年至 2013 年确定了新诊断为 AS 的患者。我们从 2012 年至 2013 年选择了 584 名开始使用生物制剂的患者，并选择了 2336 名性别、生物制剂起始年龄、AS 诊断年龄和疾病持续时间匹配的对照。我们研究了在开始使用生物制剂前 1 年内接触空气污染物与生物制剂使用之间的关联，同时调整了潜在混杂因素，包括疾病持续时间、城市化水平、月收入、Charlson 合并症指数（CCI）、虹膜炎、银屑病和用于 AS 的药物。结果显示为调整后的优势比（aOR）及其 95%置信区间（CI）。
生物制剂的使用与 CO（每 1ppm）（aOR，8.57；95%CI，2.02-36.32）和 NO2（每 10ppb）（aOR，0.23；95%CI，0.11-0.50）的暴露有关。其他独立的预测因素包括疾病持续时间（增量年，aOR，8.95）、CCI（aOR，1.31）、银屑病（aOR，25.19）、非甾体抗炎药（aOR，23.66）的使用、甲氨蝶呤（aOR，4.50；95%CI，2.93-7.00）、柳氮磺胺吡啶（aOR，12.16；95%CI，8.98-15.45）和泼尼松龙等效剂量（mg/天，aOR，1.12）。
这项全国性的基于人群的研究表明，生物制剂的报销与 CO 水平呈正相关，但与 NO 水平呈负相关。主要局限性包括缺乏关于个人吸烟状况的信息以及空气污染物之间的多重共线性。
